Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children
Authors: Izzuddin M. Aris, Wei Perng, Dana Dabelea, Amy M. Padula, Akram Alshawabkeh, Carmen M. Vélez-Vega, Judy L. Aschner, Carlos A. Camargo, Tamara J. Sussman, Anne L. Dunlop, Amy J. Elliott, Assiamira Ferrara, Christine L. M. Joseph, Anne Marie Singh, Carrie V. Breton, Tina Hartert, Ferdinand Cacho, Margaret R. Karagas, Barry M. Lester, Nichole R. Kelly, Jody M. Ganiban, Su H. Chu, Thomas G. O’Connor, Rebecca C. Fry, Gwendolyn Norman, Leonardo Trasande, Bibiana Restrepo, Diane R. Gold, Peter James, Emily Oken, Samia Baluch, Timothy Shields, Stephanie Merhar, Clement Ren, Gloria Pryhuber, Paul Moore, Rajan Wadhawan, Carol Wagner, John R Keller, Amy Reynolds, Roberta Keller, Mark Hudak, Adam Duncan, Ronald Walshburn, Susan L Teitelbaum, Annemarie Stroustrup, Andrea Lampland, Dennis Mayock, Jonathan Mansbach, Jonathan Spergel, Michelle Stevenson, Cindy Bauer, James Gern, Christine Seroogy, Casper Bendixsen, Irva Hertz-Picciotto, Catherine Karr, Alex Mason, Scott Weiss, George O’Connor, Robert Zeiger, Leonard Bacharier, Brian Carter, Carmen Marsit, Steven Pastyrnak, Charles Neal, Lynne Smith, Jennifer Helderman, Robert Tepper, Craig Newschaffer, Heather Volk, Rebecca Schmidt, Jean Kerver, Charles Barone, Patricia McKane, Nigel Paneth, Michael Elliott, Susan Schantz, Christina Porucznik, Robert Silver, Elisabeth Conradt, Michelle Bosquet-Enlow, Kathi Huddleston, Nicki Bush, Ruby Nguyen, Emily Barrett, Alison Hipwell, Kate Keenan, Christiane Duarte, Glorisa Canino, Stephen Dager, Robert Schultz, Joseph Piven, Hyagriv Simhan, Frank Gilliland, Shoreh Farzan, Tracy Bastain
Journal: JAMA Pediatrics (2023)

The extent to which physical and social attributes of neighborhoods play a role in childhood asthma remains understudied. To examine associations of neighborhood-level opportunity and social vulnerability measures with childhood asthma incidence. This cohort study used data from children in 46 cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program between January 1, 1995, and August 31, 2022. Participant inclusion required at least 1 geocoded residential address from birth and parent or caregiver report of a physician's diagnosis of asthma. Participants were followed up to the date of asthma diagnosis, date of last visit or loss to follow-up, or age 20 years. Census tract-level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) at birth, infancy, or early childhood, grouped into very low (<20th percentile), low (20th to <40th percentile), moderate (40th to <60th percentile), high (60th to <80th percentile), or very high (≥80th percentile) COI or SVI. The main outcome was parent or caregiver report of a physician's diagnosis of childhood asthma (yes or no). Poisson regression models estimated asthma incidence rate ratios (IRRs) associated with COI and SVI scores at each life stage. The study included 10 516 children (median age at follow-up, 9.1 years [IQR, 7.0-11.6 years]; 52.2% male), of whom 20.6% lived in neighborhoods with very high COI and very low SVI. The overall asthma incidence rate was 23.3 cases per 1000 child-years (median age at asthma diagnosis, 6.6 years [IQR, 4.1-9.9 years]). High and very high (vs very low) COI at birth, infancy, or early childhood were associated with lower subsequent asthma incidence independent of sociodemographic characteristics, parental asthma history, and parity. For example, compared with very low COI, the adjusted IRR for asthma was 0.87 (95% CI, 0.75-1.00) for high COI at birth and 0.83 (95% CI, 0.71-0.98) for very high COI at birth. These associations appeared to be attributable to the health and environmental and the social and economic domains of the COI. The SVI during early life was not significantly associated with asthma incidence. For example, compared with a very high SVI, the adjusted IRR for asthma was 0.88 (95% CI, 0.75-1.02) for low SVI at birth and 0.89 (95% CI, 0.76-1.03) for very low SVI at birth. In this cohort study, high and very high neighborhood opportunity during early life compared with very low neighborhood opportunity were associated with lower childhood asthma incidence. These findings suggest the need for future studies examining whether investing in health and environmental or social and economic resources in early life would promote health equity in pediatric asthma.